第讲ClinicalMethods.pptVIP

Because of their role as a primary physicians, family practitioners tend to encounter illness in its earliest stages. Early diagnosis is a special responsibility, especially in those diseases where early treatment makes a difference to prognosis. The family physician, therefore, has to be especially alert to the clinical data that distinguish serious and life-threatening illness in its early stages from less serious illness. This presents a problem. The symptoms, signs, and tests that identify diseases in their early stages are often different from those that identify them in their later stages. The sensitivity and specificity of signs and tests varies with the stage of the disease. As we will see later, this creates pitfalls for those beginning in family practice after experience limited to in-hospital medicine. Textbooks of medicine are of little help, for they do not usually tell one how to diagnose disease in its earliest stages. Another feature of the family practice context is that the illness encountered is usually undifferentiated and unorganized. By an undifferentiated illness, we mean one that has not previously been assessed, categorized, and named by a physician. In the process of diagnosis, the physician interprets the raw data presented by the patient, adds the data acquired by his or her own search, and tries to fit the illness into a disease category within his or her own frame of reference. In this way, many patients presenting to family physicians have their raw illnesses differentiated into well-known disease categories. Many patients have illnesses that defy this kind of differen-tiation An illness may be transient and self limiting, creating a functional disturbance that clears completely, leaving no evidence on which a diagnosis can be based An illness may be treated so early that it is aborted before it reaches the stage of a definitive diagnosis Family physicians see all variants of disease, they are especially liable to encounter milder